Can Endoscopes Be Cleaned?

VESTED INTEREST Dr. Max Lehfeldt was allegedly on Allergan's payroll to promote and research the company's SERI surgical scaffold system.

The channels of flexible endoscopes can harbor microbial growth and residual water even when proper reprocessing practices are followed, according to a pair of new studies, which question if enough is being done to protect patients from infections associated with these notoriously difficult-to-clean devices.

The first study, published in the American Journal of Infection Control, assessed the endoscope reprocessing, drying and storage practices in use at 3 U.S. hospitals. Visual examinations and testing designed to detect fluid and contamination in 45 reprocessed scopes revealed 49% of the devices' channels contained moisture and 71% showed traces of microbial growth. High adenosine triphosphate (ATP) levels mdash; which indicate actively growing microorganisms — were found in 22% of scopes, according to the study, which notes scopes with retained water were more likely to show signs of microbial growth.

Staff at only one of the hospitals followed proper reprocessing and drying practices, say the researchers, who point out endoscope reprocessing failed about half the time, even in the hospital where staff complied with scope handling guidelines. The researchers found a high correlation between readings on quick-check moisture indication strips and more time-consuming visual inspections of endoscope channels for residual fluid. Moisture indicator strips are therefore an inexpensive and practical way to check reprocessed scopes for left-behind fluid, according to the study's authors.

The second study, published in the journal Gut, identified contaminated duodenoscopes in 39% of 73 Dutch facilities that perform endoscopic retrograde cholangiopancreatography (ERCP). Overall, 23 of 150 scopes made by Olympus, Pentax or Fujifilm were contaminated with microorganisms originating from the gastrointestinal tract, which indicates organic matter from previous patients was still present after reprocessing.

Contamination occurred in all duodenoscopes, regardless of type and design, according to the researchers. They say current reprocessing protocols are inadequate and unsafe, and call for scope redesigns and increased microbial surveillance to limit the number of contaminated scopes that continually put patients at risk of potentially life-threatening infections.